In-utero exposure to antiretrovirals and neurodevelopment among HIV-exposed-uninfected children in Botswana.
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Author list: Chaudhury S, Mayondi GK, Williams PL, Leidner J, Shapiro R, Diseko M, Ajibola G, Holding P, Tepper V, Makhema J, Petlo C, Seage GR, Lockman S, Kammerer B
Publisher: Lippincott, Williams & Wilkins
Publication year: 2018
Journal: AIDS (0269-9370)
Journal acronym: AIDS
Volume number: 32
Issue number: 9
Start page: 1173
End page: 1183
Number of pages: 11
ISSN: 0269-9370
eISSN: 1473-5571
Languages: English-Great Britain (EN-GB)
Abstract
OBJECTIVE\nDESIGN\nMETHODS\nRESULTS\nCONCLUSION\nConflicting data exist regarding the impact of in-utero exposure to maternal combination antiretrovirals. We compared neurodevelopmental outcomes between HIV-exposed-uninfected (HEU) children exposed in utero to three-drug combination antiretroviral therapy (ART) vs. zidovudine (ZDV) monotherapy.\nProspective study of child neurodevelopment, nested within two cohorts of HIV-infected mothers and their children in Botswana (one observational, one interventional).\nThe Tshipidi and Mma Bana studies enrolled HIV-infected women during pregnancy and followed their HEU children for 24 months. Mothers took three-drug ART or ZDV during pregnancy. ART-exposed babies were mostly breastfed, and ZDV-exposed were formula-fed. Neurodevelopmental outcomes, measured at 24 months using Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) and Development Milestones Checklist (DMC), were compared in adjusted linear regression according to antiretroviral exposure.\nOf 598 HEU children with valid neurodevelopment assessments, 382 were ART-exposed and 210 were ZDV-exposed. Adjusted mean Bayley-III scores were similar among ART-exposed vs. ZDV-exposed, with adjusted mean differences (95% confidence interval): Bayley-III Cognitive: -0.3 (-1.4, 0.9); Gross Motor: 0.8 (-0.1, 1.7); Fine Motor: 0.5 (-0.2, 1.3); Expressive Language: 0.7 (-0.3, 1.7); Receptive Language: 0.1 (-0.7, 0.8); and DMC Locomotor: 0.0 (-0.5, 0.6); Fine Motor: 0.3 (-0.3, 0.8); Language: -0.1 (-0.5, 0.4); Personal-Social: 0.2 (-0.7, 1.1). Similarly, when restricted to formula-fed children in one cohort (Tshipidi), there were no differences in adjusted mean scores.\nNeurodevelopmental outcomes at 24 months of age were similar in ART-exposed vs. ZDV-exposed HEU children. Maternal ART with breastfeeding does not appear to have an adverse effect on neurodevelopment.
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